Healthcare Provider Details

I. General information

NPI: 1972278448
Provider Name (Legal Business Name): AMEYALLI CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 05/05/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE STE 200
SACRAMENTO CA
95825-6540
US

IV. Provider business mailing address

6316 33RD AVE
SACRAMENTO CA
95824-1902
US

V. Phone/Fax

Practice location:
  • Phone: 888-353-8285
  • Fax: 877-805-3084
Mailing address:
  • Phone: 888-353-8285
  • Fax: 877-805-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: